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Vergmann AS, Olsen FE, Nielsen AB, Vestergaard AH, Thomsen ASS, Konge L, Grauslund J. Lack of stereopsis does not reduce surgical performance but prolongs the learning curve of vitreoretinal surgery. Acta Ophthalmol 2024; 102:697-702. [PMID: 38269526 DOI: 10.1111/aos.16635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/06/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE To investigate whether individuals with long-term reduced stereopsis were able to obtain the same level of surgical skills in simulated vitreoretinal surgery on the Eyesi Surgical Simulator as individuals with normal stereopsis. METHODS Twenty-four medical students were recruited and divided into two groups according to their degree of stereopsis: Group 1 (n = 12) included subjects with normal stereopsis (60 arcsec or lower) and Group 2 (n = 12) included subjects with reduced stereopsis (120 arcsec or higher). Stereopsis was tested using the TNO test (Lameris Ootech BV, Nieuwegein, the Netherlands). The participants were trained in virtual reality-simulated vitreoretinal surgery and continuously measured using a test with solid validity evidence and a pre-defined pass-fail score. All data were analysed using the Wilcoxon rank sum test. RESULTS We observed no differences in overall performance scores for any of the four modules. The participants with reduced stereopsis used 5.8 more attempts in bimanual training (p = 0.04), 8.8 more attempts in removal of posterior hyaloid (p = 0.04), 9.1 more attempts in navigation training (p = 0.20) and 0.3 fewer attempts in removal of internal limiting membrane (p = 0.69). CONCLUSION The final performance scores on the Eyesi Surgical Simulator were independent of the degree of stereopsis. However, the number of attempts to achieve the pre-defined pass-fail score increased significantly with reduced stereopsis in two of four modules. These results indicate that a high degree of stereopsis is not necessary to become proficient in microsurgery but may prolong the learning curve.
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Affiliation(s)
- Anna Stage Vergmann
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Regional Centre for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Frederik Emil Olsen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Nielsen
- Regional Centre for Technical Simulation, Region of Southern Denmark, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark
| | - Anders Højslet Vestergaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ann Sofia Skou Thomsen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region of Denmark, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Lars Konge
- Regional Centre for Technical Simulation, Region of Southern Denmark, Odense, Denmark
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, Capital Region of Denmark, Copenhagen, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Sankarananthan R, Prasad S, Paul A, Koshy TA, Nagu K, Raman R, Shekhar M. Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using international council of ophthalmology-ophthalmology surgical competency assessment rubrics (ICO-OSCAR). Int Ophthalmol 2024; 44:336. [PMID: 39048844 DOI: 10.1007/s10792-024-03252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. METHODS Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. RESULTS The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. CONCLUSIONS ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.
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Affiliation(s)
- R Sankarananthan
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Senthil Prasad
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Anu Paul
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Tony Alex Koshy
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Kamatchi Nagu
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Ramalakshmi Raman
- Department of Biostatistics, Aravind Eye Care System, Madurai, India
| | - Madhu Shekhar
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India.
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Wang N, Yang S, Gao Q, Jin X. Immersive teaching using virtual reality technology to improve ophthalmic surgical skills for medical postgraduate students. Postgrad Med 2024; 136:487-495. [PMID: 38819302 DOI: 10.1080/00325481.2024.2363171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/28/2024] [Indexed: 06/01/2024]
Abstract
Medical education is primarily based on practical schooling and the accumulation of experience and skills, which is important for the growth and development of young ophthalmic surgeons. However, present learning and refresher methods are constrained by several factors. Nevertheless, virtual reality (VR) technology has considerably contributed to medical training worldwide, providing convenient and practical auxiliary value for the selection of students' sub-majors. Moreover, it offers previously inaccessible surgical step training, scenario simulations, and immersive evaluation exams. This paper outlines the current applications of VR immersive teaching methods for ophthalmic surgery interns.
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Affiliation(s)
- Ning Wang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Shuo Yang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Qi Gao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Xiuming Jin
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
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Boberg-Ans LC, Hutter DE, La Cour M, Konge L, Le A, Vangsted A, Thomsen ASS. Comparing the impact of surgical expert versus non-ophthalmologist instructors on virtual-reality surgical performance: A randomized controlled trial. Acta Ophthalmol 2024. [PMID: 38819012 DOI: 10.1111/aos.16719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To compare Manual Small Incision Cataract Surgery (MSICS) microsurgical performance in course participants who received virtual reality simulation-based training by either a surgical expert or a non-ophthalmologist instructor. SETTING Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark. DESIGN Randomized controlled trial. METHODS Residents and specialists in ophthalmology with no prior MSICS experience were included to receive virtual reality simulation training in MSICS using the HelpMeSee simulator. The participants were randomly allocated to receive training from either an experienced MSICS surgeon or a non-ophthalmologist, also known as near-peer teaching. The performances of the participants were evaluated at baseline and post-training using a MSICS proficiency-based test with evidence of validity. RESULTS Thirty participants were included in the study and 29 completed the course. There was no significant difference in final test score between the two groups (p = 0.13). The performance score of both groups of participants increased significantly after receiving the training (p < 0.001). All participants passed the proficiency-based test after receiving the training. CONCLUSION We found no significant difference in surgical proficiency-level whether the participants were trained by a surgical expert or a non-ophthalmologist instructor for MSICS in a virtual-reality based setting. The findings of this study suggest that near-peer teaching within microsurgical performance potentially could be applied with teaching outcomes comparable to a surgical expert-instructor.
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Affiliation(s)
- Lars Christian Boberg-Ans
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
- Copenhagen Academy for Medical Education and Simulation, Denmark, Denmark
| | - Daniel Ethan Hutter
- Copenhagen Academy for Medical Education and Simulation, Denmark, Denmark
- Bascom Palmer Eye Institute, Voluntary Faculty, Miami, Florida, USA
| | - Morten La Cour
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Glostrup, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Denmark, Denmark
| | - Anton Le
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
- Copenhagen Academy for Medical Education and Simulation, Denmark, Denmark
| | - Andreas Vangsted
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Ann Sofia Skou Thomsen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark
- Copenhagen Academy for Medical Education and Simulation, Denmark, Denmark
- Department of Clinical Medicine, University of Copenhagen, Glostrup, Denmark
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Nielsen BR, Alberti M, Høgild ML, Bek T, Thinggaard BS, Grauslund J, Christensen U, la Cour M. The role of phacoemulsification surgery in the incidence rate of rhegmatogenous retinal detachment. Acta Ophthalmol 2024. [PMID: 38785299 DOI: 10.1111/aos.16723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To investigate changes in the incidence rate of primary rhegmatogenous retinal detachment (RRD) surgery over time and to determine to what extent these changes can be attributed to pseudophakia. METHODS This nationwide cohort study was based on national patient registries. The study population comprised individuals at risk of RRD aged 40 years and above from 2006 to 2021 in Denmark. The primary outcome was RRD incidence, and the exposure was phacoemulsification surgery. A chart review was conducted to validate and examine the lens status of the outcome. RESULTS The crude and age-adjusted incidence rate of RRD in the Danish population increased significantly during the study period. The largest increase in RRD was seen in phakic RRD (phRRD) (65%), whereas pseudophakic RRD (pRRD) accounted for 35% of the total increase. A chart review revealed that 17% of phRRDs were misclassified as pseudophakic, resulting in pRRD accounting for a total of 45% of the increase in RRD. The prevalence of pseudophakia in Denmark grew significantly for all age groups and for both sexes (p = 10-6) from 2006 to 2021, but the 1-year incidence of pRRD in the pseudophakic population was constant throughout the entire period. CONCLUSION The incidence rate of RRD is continuing to increase in Denmark. The increase in phRRD remains undetermined, and while the risk of pRRD seemed to be constant during the study period, 45% of the overall increase in RRD could be attributed to the rise of a growing pseudophakic population.
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Affiliation(s)
- Birgitte Romme Nielsen
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark Alberti
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Morten Lyng Høgild
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Benjamin Sommer Thinggaard
- OPEN Data Explorative Data Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Ulrik Christensen
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet - Glostrup, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Du Y, Cai X, Zheng Y, Long A, Zhang M, Chen M, Zhang W, Zhu J, Guo J, Yang C. Research advances and trends in anatomy from 2013 to 2023: A visual analysis based on CiteSpace and VOSviewer. Clin Anat 2024. [PMID: 38651194 DOI: 10.1002/ca.24168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
As the cornerstone of medicine, the development of anatomy is related to many disciplines and fields and has received extensive attention from researchers. How to integrate and grasp the cutting-edge information in this field quickly is a challenge for researchers, so the aim of this study is to analyze research in anatomy using CiteSpace and VOSviewer in order to identify research hotspots and future directions. To offer a fresh viewpoint for assessing the academic influences of researchers, nations, or institutions on anatomy, and to examine the development of hotspots in anatomical study and to forecast future trends. A total of 4637 anatomy-related publications from 2013 to 2023 were collected from Web of Science Core Collection databases. Their temporal distribution, spatial distribution, cited authors, co-cited journals, keywords, and disciplinary connections in the literature were analyzed using CiteSpace and VOSviewer, and a knowledge graph was constructed. The temporal distribution shows a general fluctuation in the amount of literature published from 2013 to 2023. In spatial distribution, the total number of published articles was highest in the United States, the United Kingdom, and China, the United States leading. Tubbs, Rhoton, Iwanaga, and LaPrade are important authors in anatomy. Clinical Anatomy, Surgical and Radiologic Anatomy, and Journal of Anatomy were the most highly cited journals. Analysis of keywords and citation emergence showed that the research hotspots and trends in anatomy focused mainly on anatomy education, digital technology, and surgical management. At the same time, anatomy showed a trend toward multidisciplinary crossover, developing closer relationships with molecular biology, immunology, and clinical medicine. Current research in anatomy focuses on innovative reform of the educational model and the application and promotion of digital technology. Also, multidisciplinary cross-fertilization is an inevitable trend for the future development of anatomy.
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Affiliation(s)
- Yikuan Du
- Central Laboratory, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, China
| | - Xiaolin Cai
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Ye Zheng
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Aoxue Long
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Mengting Zhang
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Mianhai Chen
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Weichui Zhang
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Jinfeng Zhu
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
| | - Jinhua Guo
- Department of anatomy, Guangdong Medical University, Dongguan, China
| | - Chun Yang
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated Hospital, School of Basic Medical Sciences, Guangdong Medical University, Dongguan, China
- Department of anatomy, Guangdong Medical University, Dongguan, China
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Shirley ED, Renfro SH, Rocchi VJ. Mental Skills for Orthopaedic Surgery. J Am Acad Orthop Surg 2024; 32:323-330. [PMID: 38373405 DOI: 10.5435/jaaos-d-23-00775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/14/2024] [Indexed: 02/21/2024] Open
Abstract
Orthopaedic surgery training focuses primarily on the knowledge base and surgical techniques that comprise the fundamental and physical pillars of performance. It also pays much less attention to the mental pillar of performance than does the training of other specialists such as aviators, elite athletes, musicians, and Special Forces operators. However, mental skills optimize the ability to achieve the ideal state during surgery that includes absolute focus with the right amount of confidence and stress. The path to this state begins before surgery with visualization of the surgical steps and potential complications. On the day of surgery, the use of compartmentalization, performance aspirations, performance breathing, and keeping the team focused facilitates achieving and maintaining the proper mental state. Considering the similarities between surgery and other fields of expertise that do emphasize the mental pillar, including this training in orthopaedic residencies, is likely beneficial.
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Affiliation(s)
- Eric D Shirley
- From the Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
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Li W, Ma S, Zhou L, Konge L, Pan J, Hui J. The bibliometric analysis of extended reality in surgical training: Global and Chinese perspective. Heliyon 2024; 10:e27340. [PMID: 38495188 PMCID: PMC10943385 DOI: 10.1016/j.heliyon.2024.e27340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/12/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
Objectives The prospect of extended reality (XR) being integrated with surgical training curriculum has attracted scholars. However, there is a lack of bibliometric analysis to help them better understand this field. Our aim is to analyze relevant literature focusing on development trajectory and research directions since the 21st century to provide valuable insights. Methods Papers were retrieved from the Web of Science Core Collection. Microsoft Excel, VOSviewer, and CiteSpace were used for bibliometric analysis. Results Of the 3337 papers published worldwide, China contributed 204, ranking fifth. The world's enthusiasm for this field has been growing since 2000, whereas China has been gradually entering since 2001. Although China had a late start, its growth has accelerated since around 2016 due to the reform of the medical postgraduate education system and the rapid development of Chinese information technology, despite no research explosive period has been yet noted. International institutions, notably the University of Toronto, worked closely with others, while Chinese institutions lacked of international and domestic cooperation. Sixteen stable cooperation clusters of international scholars were formed, while the collaboration between Chinese scholars was not yet stable. XR has been primarily applied in orthopedic surgery, cataract surgery, laparoscopic training and intraoperative use in neurosurgery worldwide. Conclusions There is strong enthusiasm and cooperation in the international research on the XR-based surgical training. Chinese scholars are making steady progress and have great potential in this area. There has not been noted an explosive research phase yet in the Chinese pace. The research on several surgical specialties has been summarized at the very first time. AR will gradually to be more involved and take important role of the research.
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Affiliation(s)
- Wei Li
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Ma
- Medical Simulation Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Zhou
- School of Postgraduate Education, Southern Medical University, Guangzhou, China
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES) Rigshospitalet, Copenhagen, Denmark
| | - Junjun Pan
- State Key Laboratory of Virtual Reality Technology and Systems, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
- PENG CHENG Laboratory, Shenzhen, China
| | - Jialiang Hui
- Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou City, China
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Zaki MM, Joshi RS, Joseph JR, Saadeh YS, Kashlan ON, Godzik J, Uribe JS, Park P. Virtual Reality-Enabled Resident Education of Lateral-Access Spine Surgery. World Neurosurg 2024; 183:e401-e407. [PMID: 38143034 DOI: 10.1016/j.wneu.2023.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE Lateral-access spine surgery has many benefits, but adoption has been limited by a steep learning curve. Virtual reality (VR) is gaining popularity and lends itself as a useful tool in enhancing neurosurgical resident education. We thus sought to assess whether VR-based simulation could enhance the training of neurosurgery residents in lateral spine surgery. METHODS Neurosurgery residents completed a VR-based lateral spine module on lateral patient positioning and performing lateral lumbar interbody fusion using the PrecisionOS VR system on the Meta Quest 2 headset. Simulation occurred 1×/week every other week for a total of 3 simulations over 6 weeks. Pre- and postintervention surveys as well as intrasimulation performance metrics were assessed over time. RESULTS The majority of resident participants showed improvement in performance scores, including an automated PrecisionOS precision score, number of radiographs used within the simulation, and time to completion. All participants showed improvement in comfort with anatomic landmarks for lateral access surgery, confidence performing lateral surgery without direct supervision, and assessing fluoroscopy in spine surgery for hardware placement and image interpretation. Participant perception on the utility of VR as an educational tool also improved. CONCLUSIONS VR-based simulation enhanced neurosurgical residents' ability to understand lateral access surgery. Immersive surgical simulation resulted in improved resident confidence with surgical technique and workflow, perceived improvement in anatomical knowledge, and simulation performance scores. Trainee perceptions on virtual simulation and training as a curriculum supplement also improved following completion of VR training.
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Affiliation(s)
- Mark M Zaki
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rushikesh S Joshi
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacob R Joseph
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Yamaan S Saadeh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jakub Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Paul Park
- Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, Tennessee, USA.
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Kitic N, Bourges JL. Preclinical training of future ocular surgeons: a French opinion-based study. BMC MEDICAL EDUCATION 2024; 24:129. [PMID: 38336776 PMCID: PMC10858601 DOI: 10.1186/s12909-024-05124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess ophthalmology residents satisfaction regarding surgical training during residency in France. METHODS A questionnaire consisting of 28 questions was designed and sent to residents of ophthalmology across the 27 French regions. RESULTS A total of 30.3% ophthalmology residents in France completed our questionnaire. All French regions participated. They rated 5,27 ± 2.42/10 the global surgical training during residency. They had performed at least one step of any type of ocular surgery for 93.4% of them, while 80.7% had completed at least one full cataract surgery, by the beginning of their second year of residency on average (Paris: 2.59 ± 1.36 semesters; regions: 4.05 ± 1.96 semesters, p < 0.0001). Only 48.9% identified a surgical mentor during their residency, but 82.2% did not clearly identify surgical goals & objectives during their training. Simulation was available for any type of ocular surgery to all residents in the Paris (Île-de-France) region and to 78.1% in other regions (p < 0.005). Residents who accessed drylabs and wetlabs gave a satisfaction score of 7.31 ± 1.89/10 and 6.39 ± 2.15/10 to it respectively. Simulation was a mandatory part of the curriculum for 35.2% of the resident. They commented on on reduced access to subspecialized surgery. They were willing for more access to simulation and surgery on real patients, as well for closer mentoring and clearly defined surgical goals within the curriculum. CONCLUSION Ophthalmology residents seemed globally satisfied with their surgical training nationwide, although we observed disparities across region. They largely acknowledged a lack of standard procedures nationwide. They acclaimed simulation during the initial phase of residency, progressively switching towards surgery on real patients. An "operating license" during residency could be a viable way for the resident to demonstrate that they have acquired enough surgical abilities to perform surgery on real patients.
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Affiliation(s)
- Nicolas Kitic
- Rothschild Foundation Hospital, Paris, France.
- Sorbonne Université, Paris, France.
| | - Jean-Louis Bourges
- INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Centre de Recherche des Cordeliers, Université Paris Cité, Paris, France
- Department of Ophthalmology, Cochin Hospital, AP-HP, Paris, France
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Tang DHY, Østdal TB, Vamadevan A, Konge L, Houlind K, Stadeager M, Bjerrum F. No difference between using short and long intervals for distributed proficiency-based laparoscopy simulator training: a randomized trial. Surg Endosc 2024; 38:300-305. [PMID: 37993677 PMCID: PMC10776690 DOI: 10.1007/s00464-023-10522-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Simulation-based training is increasingly used to acquire basic laparoscopic skills. Multiple factors can influence training, e.g., distributed practice is superior to massed practice in terms of efficiency. However, the optimal interval between training sessions is unclear. The objective of this trial was to investigate if shorter intervals between sessions are more efficient than longer intervals during proficiency-based laparoscopy simulator training. METHODS A randomized simulation-based trial where medical students (n = 39) were randomized to proficiency-based training with either 1-2 days (intervention group) or 6-8 days (control group) between training sessions. Both groups practiced a series of basic tasks and a procedural module until proficiency level on the LapSim® simulator. Both groups were given instructor feedback upon request. After reaching proficiency, participants were invited back for a retention test 3-5 weeks later and practiced the same tasks to proficiency again. RESULTS The mean time to reach proficiency during training was 291 (SD 89) and 299 (SD 89) min in the intervention and control group, respectively (p = 0.81). During the retention test, the mean time to reach proficiency was 94 (SD 53) and 96 (SD 39) minutes in the intervention and control groups, respectively (p = 0.91). CONCLUSION We found no difference whether practicing with shorter intervals or longer intervals between training sessions when examining time to proficiency or retention.
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Affiliation(s)
- Diana Hai Yen Tang
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark.
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Theresa Bruun Østdal
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Houlind
- The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Vascular Surgery, Hospital Lillebaelt, University of Southern Denmark, Odense, Denmark
| | - Morten Stadeager
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Surgery, Hvidovre Hospital, Copenhagen, Denmark
| | - Flemming Bjerrum
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Ryesgade 53B, 2100, Copenhagen, Denmark
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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Hussain AK, Kakakhel MM, Ashraf MF, Shahab M, Ahmad F, Luqman F, Ahmad M, Mohammed Nour A, Varrassi G, Kinger S. Innovative Approaches to Safe Surgery: A Narrative Synthesis of Best Practices. Cureus 2023; 15:e49723. [PMID: 38161861 PMCID: PMC10757557 DOI: 10.7759/cureus.49723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
By encompassing a wide range of best practices within the ever-changing realm of modern surgical care, this exhaustive narrative compendium attempts to unravel the complex tapestry of novel approaches to safe surgery. Within the context of a dynamic surgical environment, this research endeavors to illuminate and integrate state-of-the-art methods that collectively methodically improve patient safety. The narrative elucidates a diverse array of practices that seek to revolutionize the paradigm of safe surgery, emphasizing technological progress, patient-centric approaches, and global viewpoints. The combined effectiveness of these methods in fostering an all-encompassing culture of safety, improving surgical precision, and decreasing complications is revealed by the results obtained from their implementation. The recognition of the dynamic interplay among multiple components, including the active participation of patients, the integration of cutting-edge technologies, and the establishment of comprehensive quality improvement programs, is fundamental to this narrative. By their collective composition, these components support the notion that secure surgical practices are intricate and interrelated. The present synthesis functions as a fundamental resource for healthcare professionals, policymakers, and researchers, providing an enlightening examination of the current condition of secure surgical practices. By emphasizing the promotion of innovation, continuous development, and the utmost quality of patient care, it offers a strategic guide for navigating the complex terrain of safe surgery. In the ever-evolving landscape of surgical care, this narrative synthesis serves as a guiding principle for stakeholders striving to understand better and implement safe surgical procedures in various healthcare environments.
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Affiliation(s)
- Amer Kamal Hussain
- Urology, Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham, GBR
| | - Muhammad Maaz Kakakhel
- Trauma and Orthopaedics, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, GBR
| | | | | | - Fahad Ahmad
- Upper Gastrointestinal Surgery, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Faizan Luqman
- Ophthalmology, Khyber Medical College, Peshawar, PAK
- Ophthalmology, Medical Teaching Institution (MTI) Khyber Teaching Hospital, Peshawar, PAK
| | - Mahmood Ahmad
- Trauma and Orthopaedics, Royal College of Surgeons, Dublin, IRL
| | - Ayman Mohammed Nour
- Urology, Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham, GBR
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Roizenblatt M, Gehlbach PL, Marin VDG, Roizenblatt A, Saraiva VS, Nakanami MH, Noia LC, Song Watanabe SE, Yasaki ES, Passos RM, Magalhães Junior O, Fernandes RAB, Stefanini FR, Caiado R, Jiramongkolchai K, Farah ME, Belfort R, Maia M. A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery. Ophthalmol Retina 2023; 7:940-947. [PMID: 37164313 DOI: 10.1016/j.oret.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance. DESIGN Self-controlled cohort study. PARTICIPANTS Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice. METHODS Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance. MAIN OUTCOME MEASURES Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation. RESULTS Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning. CONCLUSIONS This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Peter L Gehlbach
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vitor D G Marin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius S Saraiva
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio H Nakanami
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana C Noia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sung E Song Watanabe
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erika S Yasaki
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato M Passos
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Rafael Caiado
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Michel E Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, Brazil; Vision Institute, Instituto Paulista de Estudos e Pesquisas em Oftalmologia (IPEPO), Universidade Federal de São Paulo, São Paulo, Brazil
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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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15
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Ng DS, Yip BHK, Young AL, Yip WWK, Lam NM, Li KK, Ko ST, Chan WH, Aryasit O, Sikder S, Ferris JD, Pang CP, Tham CC. Cost-effectiveness of virtual reality and wet laboratory cataract surgery simulation. Medicine (Baltimore) 2023; 102:e35067. [PMID: 37800761 PMCID: PMC10552957 DOI: 10.1097/md.0000000000035067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance. METHODS Residents were randomized to a combination of virtual reality and wet laboratory phacoemulsification or wet laboratory phacoemulsification. A reference control group consisted of trainees who had wet laboratory training without phacoemulsification. All trainees were assessed on operating theater performance in 3 sequential cataract patients. International Council of Ophthalmology Surgical Competency Assessment Rubric-phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and cost data were used to determine the incremental cost-effectiveness ratio (ICER). A decision model was constructed to indicate the most cost-effective simulation training strategy based on the willingness to pay (WTP) per ICO OSCAR phaco score gained. RESULTS Twenty-two trainees who performed phacoemulsification in 66 patients were analyzed. Trainees who had additional virtual reality simulation achieved higher mean ICO OSCAR phaco scores compared with trainees who had wet laboratory phacoemulsification and control (49.5 ± standard deviation [SD] 9.8 vs 39.0 ± 15.8 vs 32.5 ± 12.1, P < .001). Compared with the control group, ICER per ICO OSCAR phaco of wet laboratory phacoemulsification was $13,473 for capital cost and $2209 for recurring cost. Compared with wet laboratory phacoemulsification, ICER per ICO OSCAR phaco of additional virtual reality simulator training was US $23,778 for capital cost and $1879 for recurring cost. The threshold WTP values per ICO OSCAR phaco score for combined virtual reality simulator and wet laboratory phacoemulsification to be most cost-effective was $22,500 for capital cost and $1850 for recurring cost. CONCLUSIONS Combining virtual reality simulator with wet laboratory phacoemulsification training is effective for skills transfer in the operating theater. Despite of the high capital cost of virtual reality simulator, its relatively low recurring cost is more favorable toward cost-effectiveness.
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Affiliation(s)
- Danny S. Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Hong Kong Baptist Hospital, Hong Kong, China
| | - Benjamin H. K. Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Wilson W. K. Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Nai M. Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kenneth K. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- United Christian Hospital, Hong Kong, China
| | - Simon T. Ko
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - John D. Ferris
- Ophthalmology, Gloucestershire Hospitals, National Health Service Foundation Trust, Cheltenham, United Kingdom
| | - Chi P. Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
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Ducloyer JB, Poinas A, Duchesne L, Caillet P, Ivan C, Lejus-Bourdeau C, Limousin N, Desmidt T, Pladys P, Pisella PJ, Bernard A, Lardy H, Gohier P, Martin L, Mouriaux F, Lebranchu P, Khanna RK. Educational Concerns About the Safety of Cataract Surgery During Residency: The E3CAPS Pedagogic Study. Ophthalmol Ther 2023; 12:2801-2812. [PMID: 37531031 PMCID: PMC10441871 DOI: 10.1007/s40123-023-00774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs' successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems. METHODS AND PLANNED OUTCOMES This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the "College des Ophtalmologistes Universitaires de France" in order to set up a future "licence to operate." Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT05722080.
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Affiliation(s)
- Jean-Baptiste Ducloyer
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Alexandra Poinas
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France.
| | - Léa Duchesne
- Public Health Department, CHU Nantes-Nantes University, Nantes, France
| | - Pascal Caillet
- Public Health Department, CHU Nantes-Nantes University, Nantes, France
| | - Catherine Ivan
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Corinne Lejus-Bourdeau
- Department of Anaesthesia and Intensive Care, CHU Nantes-Nantes University, Nantes, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, Tours, France
| | - Thomas Desmidt
- Inserm, UMR 1253, IBrain, Université de Tours, Tours, France
- CHU de Tours, Tours, France
| | - Patrick Pladys
- LTSI-UMR 1099, INSERM, CHU Rennes-Rennes University, Rennes, France
| | - Pierre-Jean Pisella
- Department of Ophthalmology, CHU Tours-Bretonneau Hospital, 37000, Tours, France
| | - Anne Bernard
- Department of Cardiology, Tours University Hospital, Tours, France
| | - Hubert Lardy
- Division of Pediatric Surgery, CHU-Centre de Pédiatrie de Clocheville, Tours, France
| | - Philippe Gohier
- Department of Ophthalmology, CHU de Angers, 49100, Angers, France
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, Angers, France
- All'Sims Centre for Healthcare Simulation, Angers University Hospital, Angers, France
| | - Frederic Mouriaux
- Ophthalmology Department, CHU Rennes-Université Rennes 1, Rennes, France
| | - Pierre Lebranchu
- Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France
- Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France
| | - Raoul Kanav Khanna
- Department of Ophthalmology, UMR 1253, iBrain, Bretonneau University Hospital of Tours, Tours, France
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Chen G, Jin S, Xia Q, Wang Z, Shi Z, Chen G, Hong Y, Fan X, Lin H. Insight into the history and trends of surgical simulation training in education: a bibliometric analysis. Int J Surg 2023; 109:2204-2213. [PMID: 37204478 PMCID: PMC10442119 DOI: 10.1097/js9.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Surgical simulation training enables surgeons to acquire clinical experience or skills from the operating room to the simulation environment. Historically, it has changed with advances in science and technology. Moreover, no previous study has analyzed this field from the bibliometric analysis dimension. The study aimed to review changes in surgical simulation training worldwide using bibliometric software. MATERIALS AND METHODS Two searches were performed on the core collection database, Web of Science, regarding data from 1991 to the end of 2020 using three topic words (surgery, training, and simulation). From 1 January 2000, to 15 May 2022, the keyword 'robotic' was added for the hotspot exploration. The data were chiefly analyzed by publication date, country, author(s), and keywords using bibliometric software. RESULTS A total of 5285 articles were initially analyzed, from which it was clear that laparoscopic skill, three-dimensional printing, and virtual reality were the main focuses during those study periods. Subsequently, 348 publications on robotic surgery training were identified. CONCLUSION This study systematically summarizes the current status in the field of surgical simulation training and provides insights into the research focuses and future hotspot in a global context.
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Affiliation(s)
- Guoqiao Chen
- Department of General Surgery
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | | | | | - Zhifei Wang
- Department of General Surgery, Zhejiang Province People’s Hospital
| | | | | | - Yucai Hong
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | | | - Hui Lin
- Department of General Surgery
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
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Mondal S, Kelkar AS, Singh R, Jayadev C, Saravanan VR, Kelkar JA. What do retina fellows-in-training think about the vitreoretinal surgical simulator: A multicenter survey. Indian J Ophthalmol 2023; 71:3064-3068. [PMID: 37530282 PMCID: PMC10538810 DOI: 10.4103/ijo.ijo_381_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To profile vitreoretinal (VR) fellows-in-training from India exposed to the Eyesi surgical simulator, to identify potential barriers to voluntary use, and enumerate the most preferred tools and tasks before incorporating them into a formal skill-transfer curriculum. Methods A questionnaire consisting of 22 questions was designed and circulated through an online portal (surveymonkey.com) to four different institutes of India having a VR surgical fellowship program and using a functional Eyesi (Haag-Streit) simulator. All fellows and trainees who were exposed to the simulator were eligible to participate, irrespective of time spent on the simulator and exposure to training steps on real patients. The responses collected were private and anonymous. Results Of the 37 respondents, most (n = 25, 68%) considered surgical simulators to be the best training tool before operating on the human eye. A majority (n = 35, 94.5%) of participants spent <3 h per week on the simulator, which, most (n = 30, 81%) felt was not enough time. The main reasons for this underutilization were work-hour limitations (54.8%), lack of a structured training program (19.3%), or a dedicated supervisor (16.1%). Again, the majority (n = 33, 89%) of participants responded that VR surgical skills acquired during simulator training were transferrable to the operating room, which was reflected by their response (n = 31, 83.7%) that simulator-based training should be made mandatory before operating room exposure. Conclusion This study gives an insight into the overall practice patterns and preferences in simulation training of surgical VR fellows-in-training across India. It indicates that the simulator is extremely helpful to fellows and if adopted, VR surgical simulators with organized, directed, and supervised sessions will considerably improve the surgical training experience.
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Affiliation(s)
- Sukanya Mondal
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Aditya S Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Ramandeep Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chaitra Jayadev
- Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | | | - Jai A Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
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Khan A, Rangu N, Thanitcul C, Riaz KM, Woreta FA. Ophthalmic Education: The Top 100 Cited Articles in Ophthalmology Journals. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e132-e143. [PMID: 37502126 PMCID: PMC10370640 DOI: 10.1055/s-0043-1771044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023]
Abstract
Purpose To identify the top 100 (T100) cited articles on ophthalmic education and examine trends and areas of focus in ophthalmic education. Methods A literature search was conducted for articles published between 2011 and 2021 related to ophthalmic education within ophthalmology journals using the ISI Web of Science Core Collection database. The search was performed in June 2022 and was conducted using the search phrase ([educat* OR teach* OR instruct* OR train* OR "medical student*" OR residen* OR fellow* OR undergrad* OR postgrad* OR "faculty" OR "attending"] AND *ophthalm*). Results were analyzed using VOSviewer v.1.6.18 and statistical analysis was performed using Microsoft Excel. Results The majority of articles were published in the Journal of Cataract & Refractive Surgery (19%), followed by Ophthalmology (12%), and Eye (12%). Articles were most often published in the year 2013 (15%), followed by 2014 (12%) and 2012 (12%). Articles most commonly originated from English-speaking countries, including the United States (43%), England (14%), Canada (8%), and India (8%). Topics most often examined in ophthalmic education were resident education (51%), medical school education (21%), and surgical training (21%). The most common study types were cohort studies (22%), case series (21%), and prospective trials (16%). There were 16 institutions that produced more than one article in the T100 articles list. Conclusion The T100 articles on ophthalmic education were primarily U.S. based and focused on resident education, surgical training, and medical school ophthalmic curriculum. Further research into ophthalmic education is warranted to establish evidence-based curricula guidelines.
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Affiliation(s)
- Asher Khan
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Neal Rangu
- College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Chanon Thanitcul
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kamran M. Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma
| | - Fasika A. Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hutter DE, Wingsted L, Cejvanovic S, Jacobsen MF, Ochoa L, González Daher KP, la Cour M, Konge L, Thomsen ASS. A validated test has been developed for assessment of manual small incision cataract surgery skills using virtual reality simulation. Sci Rep 2023; 13:10655. [PMID: 37391411 PMCID: PMC10313684 DOI: 10.1038/s41598-023-32845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/03/2023] [Indexed: 07/02/2023] Open
Abstract
This study investigates the validity evidence of metrics used for the assessment of surgical skills for Manual Small Incision Cataract Surgery (MSICS) in a virtual reality simulator. MSICS surgery is a low-cost, low-technology cataract surgery technique, which is widely used in low- and middle-income countries. However, there is a lack of cataract surgeons globally, and efficient and evidence-based training of new surgeons is needed. In order to investigate the validity of simulator metrics, we included three groups of participants: (1) MSICS novices who were ophthalmologists with no cataract surgery experience, (2) MSICS novices who were experienced phacoemulsification cataract surgeons, but with no MSICS experience, and (3) experienced phacoemulsification and MSICS surgeons. The evaluation included 11 steps of the MSICS procedure, and all simulator metrics for those steps were reviewed. Of the 55 initial metrics, 30 showed high positive discriminative ability. A test passing score of 20 out of 30 was established, and one of 15 novices with no MSICS experience (mean score 15.5) and 7 out of 10 experienced MSICS surgeons (mean score 22.7) passed the test. We have developed and established validity evidence for a test for MSICS skills in a virtual reality simulator for future use in proficiency-based training and evidence-based testing of training interventions.
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Affiliation(s)
- Daniel E Hutter
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.
| | - Line Wingsted
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Sanja Cejvanovic
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Mads Forslund Jacobsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Luis Ochoa
- Instituto Mexicano De Oftalmología (IMO), Querétaro, Mexico
| | | | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Ann Sofia Skou Thomsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
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21
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Pettinelli NJ, Lee AY, Lee MS, Mahatme RJ, Gillinov SM, Jimenez AE. Virtual Reality Is an Effective Tool for Learning Techniques in Arthroplasty: A Systematic Review and Meta-Analysis. JAAOS: GLOBAL RESEARCH AND REVIEWS 2023; 7. [PMCID: PMC10284329 DOI: 10.5435/jaaosglobal-d-23-00078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
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22
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Rasic G, Parikh PP, Wang ML, Keric N, Jung HS, Ferguson BD, Altieri MS, Nahmias J. The silver lining of the pandemic in surgical education: virtual surgical education and recommendations for best practices. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:59. [PMID: 38013862 PMCID: PMC10205563 DOI: 10.1007/s44186-023-00137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 11/29/2023]
Abstract
Virtual education is an evolving field within the realm of surgical training. Since the onset of the COVID-19 pandemic, the application of virtual technologies in surgical education has undergone significant exploration and advancement. While originally developed to supplement in-person curricula for the development of clinical decision-making, virtual surgical education has expanded into the realms of clinical decision-making, surgical, and non-surgical skills acquisition. This manuscript aims to discuss the various applications of virtual surgical education as well as the advantages and disadvantages associated with each education modality, while offering recommendations on best practices and future directions.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA USA
| | - Priti P. Parikh
- Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH USA
| | - Ming-Li Wang
- Department of Surgery, University of New Mexico, Albuquerque, NM USA
| | - Natasha Keric
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, Banner-University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, AZ USA
| | - Hee Soo Jung
- Division of Acute Care and Regional General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Benjamin D. Ferguson
- Division of Hepatopancreatobiliary Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM USA
| | - Maria S. Altieri
- Division of Gastrointestinal Surgery, Department of Surgery, Pennsylvania Hospital, Penn Medicine, Philadelphia, PA USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California Irvine, Orange, CA USA
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23
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Lee S, Shetty AS, Cavuoto L. Modeling of Learning Processes Using Continuous-Time Markov Chain for Virtual-Reality-Based Surgical Training in Laparoscopic Surgery. IEEE TRANSACTIONS ON LEARNING TECHNOLOGIES 2023; 17:462-473. [PMID: 38617582 PMCID: PMC11013959 DOI: 10.1109/tlt.2023.3236899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Recent usage of Virtual Reality (VR) technology in surgical training has emerged because of its cost-effectiveness, time savings, and cognition-based feedback generation. However, the quantitative evaluation of its effectiveness in training is still not studied thoroughly. This paper demonstrates the effectiveness of a VR-based surgical training simulator in laparoscopic surgery and investigates how stochastic modeling represented as Continuous-time Markov-chain (CTMC) can be used to explicit the training status of the surgeon. By comparing the training in real environments and in VR-based training simulators, the authors also explore the validity of the VR simulator in laparoscopic surgery. The study further aids in establishing learning models of surgeons, supporting continuous evaluation of training processes for the derivation of real-time feedback by CTMC-based modeling.
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Affiliation(s)
- Seunghan Lee
- Industrial and Systems Engineering Department at Mississippi State University
| | | | - Lora Cavuoto
- Industrial and Systems Engineering at the University at Buffalo, Buffalo, NY, USA
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Shi H, Lu P, Yu D, Wang J, Wang Z, Zhuang B, Shao C, Liu C, Liu B. The training of wrist arthroscopy. Front Med (Lausanne) 2022; 9:947459. [PMID: 36590938 PMCID: PMC9800421 DOI: 10.3389/fmed.2022.947459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The wrist is a complex joint that bridges the hand to the forearm. Patients with wrist disorders increasingly prefer minimally invasive procedures for wrist joint diagnosis and treatment. Wrist arthroscopy offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. However, it requires a high level of technical ability for wrist arthroscopy practitioners. Therefore, an improved focus on wrist arthroscopy training combining new educational media and traditional practice should aid in the development of novel wrist arthroscopy training mode. This article aims to describe the status of wrist training and evaluation systems and introduce a new progressive wrist training system.
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Affiliation(s)
- Haifei Shi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pan Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Pan Lu
| | - Dongdong Yu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiwen Wang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Zhenhua Wang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Baotang Zhuang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Chao Shao
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Chang Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Xicheng District, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Xicheng District, Beijing, China,*Correspondence: Bo Liu
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25
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Ong J, Hariprasad SM, Chhablani J. Into the RetinaVerse: A New Frontier of Retina in the Metaverse. Ophthalmic Surg Lasers Imaging Retina 2022; 53:595-600. [PMID: 36378613 DOI: 10.3928/23258160-20221017-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Fereydooni N, Tenenboim E, Walker BN, Peeta S. Incorporating Situation Awareness Cues in Virtual Reality for Users in Dynamic in-Vehicle Environments. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:3865-3873. [PMID: 36048985 DOI: 10.1109/tvcg.2022.3203086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The increasing ubiquity and mobility of virtual reality (VR) devices has introduced novel use cases, one of which is using VR in vehicles, both human-driven and fully automated. However, the effects of the adoption of VR-in-the-car on user task performance, safety, trust, and perceived risk are still largely unknown or not fully understood. Blocking out the physical world and substituting it with a virtual environment has many potential benefits including fewer distractions and greater productivity. However, one shortcoming of this seclusion is losing situation awareness which becomes critical in dynamic, in-vehicle environments, even when the user is not in the driver's seat. Hence, this study aims to understand the effects of providing VR users with situation awareness cues about the real world, when riding in a human-driven or a fully automated car. The results of this driving simulator experiment provide valuable insights into passengers' experience and their information needs while immersed in VR environments. Identifying passengers' unique challenges and needs, as well as developing solutions for them, is expected to improve users' travel experience towards a wider adoption of VR devices.
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Mathis T, Mouchel R, Malecaze J, Garcin T, Mautuit T, Kodjikian L, Burillon C, Druette L, Denis P. Evaluation of the time required to complete a cataract training program on EyeSi surgical simulator during the first-year residency. Eur J Ophthalmol 2022; 33:11206721221136322. [PMID: 36317323 DOI: 10.1177/11206721221136322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To evaluate the time required to complete a cataract training program for first-year ophthalmology residents using the EyeSi simulator. In addition, evaluate whether the simulator improves virtual performance of cataract surgery during the program. METHODS We prospectively included first-year ophthalmology residents who had no experience of cataract surgery. The EyeSi simulator was used, and residents were able to follow the cataract training program, including course A (the easiest) through to course D (the hardest). In course B and above, a "cataract challenge" is proposed to the trainee every hour of simulation. RESULTS A total of 24 participants were included in the study. During the study period, the mean (SD) total time spent on the surgical simulator was 815.6 (174.7) minutes. All the participants completed courses A and B within a mean (SD) of 366.7 (108.0) minutes. A total of 22 residents (91.7%) residents completed course C, and 5 (20.8%) course D. The mean (SD) best score on cataract challenge was 445.6/500 (40.2; range: 330-493) and was obtained in a mean (SD) 7.6 (2.6) attempts. All the residents obtained a score ≥ 60%. The best score in cataract challenge was not correlated to the time spent to achieve courses A and B (r = -0.37, p = 0.0726). CONCLUSIONS The time required to complete a basic cataract training program is possible during the first-year residency. The scores obtained in the cataract challenge also increased during the training program and should lead to better surgery skills in these young ophthalmologists.
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Affiliation(s)
- Thibaud Mathis
- 386696Service d'Ophtalmologie, 423788Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, 56440Université Lyon 1, Villeurbanne, France
| | - Romain Mouchel
- Service d'Ophtalmologie, 36609Hôpital Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Sud, 56440Université Lyon 1, Pierre-Bénite, France
| | - Jean Malecaze
- Service d'Ophtalmologie, 27006Hôpital Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Thibaud Garcin
- Service d'Ophtalmologie, 26926Hôpital Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Thibaud Mautuit
- Service d'Ophtalmologie, Hôpital de Grenoble, Grenoble, France
| | - Laurent Kodjikian
- 386696Service d'Ophtalmologie, 423788Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, 56440Université Lyon 1, Villeurbanne, France
| | - Carole Burillon
- Service d'Ophtalmologie, 36609Hôpital Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
- Faculté de Médecine Lyon Sud, 56440Université Lyon 1, Pierre-Bénite, France
| | - Loïc Druette
- Faculté de Médecine Lyon Sud, 56440Université Lyon 1, Pierre-Bénite, France
| | - Philippe Denis
- 386696Service d'Ophtalmologie, 423788Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Lockington D, Saleh GM, Spencer AF, Ferris J. Cost and time resourcing for ophthalmic simulation in the UK: a Royal College of Ophthalmologists' National Survey of regional Simulation Leads in 2021. Eye (Lond) 2022; 36:1973-1976. [PMID: 34616004 PMCID: PMC9499937 DOI: 10.1038/s41433-021-01796-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Ophthalmic simulation is cost-effective in complication prevention. However, there is no consistent resource allocation to provide the necessary time and finance to sustain such activities. We wished to identify the current support for the regional Simulation Leads in the UK. METHODS An online SurveyMonkey questionnaire was sent to all 26 UK ophthalmic regional Simulation Leads in February 2021 regarding current simulation activity and the degree of time and resource support available. RESULTS There were 22 responses within 1 month (84.6% response rate). 72.7% run regular simulation induction events for new trainees. 60% run mandatory laser simulation events. 38.1% run immersive simulation (vitreous loss fire drill). 47.6% run yearly sub-specialty events. 45.5% were required to make additional work arrangements to run simulation events. 77.3% had no job plan time allocation for simulation. 59.1% dedicated >1 hr/week to simulation. 68.2% EYESI simulators were purchased via charity/endowments. 72.7% had access to dedicated dry lab simulation (40.9% wet lab). 40.9% used deanery funds to purchase initial model eyes (supplemented by charity (36.4%) and endowments (31.8%)). 65% used unspent study leave budgets for ongoing model eyes, yet 15% reported trainees purchasing their own. CONCLUSION Nearly all ophthalmic simulation in the UK is undertaken via goodwill and personal commitment to excellence by the regional Simulation Leads. There is minimal allowance of time or finance for these vital activities, which is sporadic at best, and unsustainable. We call for the necessary investment and dedicated time allocation to permit ophthalmic simulation to be supported and maintained.
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Affiliation(s)
- David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
| | - George M Saleh
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK
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Evolution and Applications of Artificial Intelligence to Cataract Surgery. OPHTHALMOLOGY SCIENCE 2022; 2:100164. [PMID: 36245750 PMCID: PMC9559105 DOI: 10.1016/j.xops.2022.100164] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/27/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Topic Despite significant recent advances in artificial intelligence (AI) technology within several ophthalmic subspecialties, AI seems to be underutilized in the diagnosis and management of cataracts. In this article, we review AI technology that may soon become central to the cataract surgical pathway, from diagnosis to completion of surgery. Clinical Relevance This review describes recent advances in AI in the preoperative, intraoperative, and postoperative phase of cataract surgery, demonstrating its impact on the pathway and the surgical team. Methods A systematic search of PubMed was conducted to identify relevant publications on the topic of AI for cataract surgery. Articles of high quality and relevance to the topic were selected. Results Before surgery, diagnosis and grading of cataracts through AI-based image analysis has been demonstrated in several research settings. Optimal intraocular lens (IOL) power to achieve the desired postoperative refraction can be calculated with a higher degree of accuracy using AI-based modeling compared with traditional IOL formulae. During surgery, innovative AI-based video analysis tools are in development, promoting a paradigm shift for documentation, storage, and cataloging libraries of surgical videos with applications for teaching and training, complication review, and surgical research. Situation-aware computer-assisted devices can be connected to surgical microscopes for automated video capture and cloud storage upload. Artificial intelligence-based software can provide workflow analysis, tool detection, and video segmentation for skill evaluation by the surgeon and the trainee. Mixed reality features, such as real-time intraoperative warnings, may have a role in improving surgical decision-making with the key aim of reducing complications by recognizing surgical risks in advance and alerting the operator to them. For the management of patient flow through the pathway, AI-based mathematical models generating patient referral patterns are in development, as are simulations to optimize operating room use. In the postoperative phase, AI has been shown to predict the posterior capsule status with reasonable accuracy, and can therefore improve the triage pathway in the treatment of posterior capsular opacification. Discussion Artificial intelligence for cataract surgery will be as relevant as in other subspecialties of ophthalmology and will eventually constitute a future cornerstone for an enhanced cataract surgery pathway.
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Lowater SJ, Grauslund J, Vergmann AS. Modern Educational Simulation-Based Tools Among Residents of Ophthalmology: A Narrative Review. Ophthalmol Ther 2022; 11:1961-1974. [PMID: 36001249 DOI: 10.1007/s40123-022-00559-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION With no specific overview on simulation-based training for educational purposes among residents in ophthalmology, this narrative review attempts to highlight the current literature on modern educational simulation-based tools used to educate residents in ophthalmology. METHODS We searched databases Web of Science and PubMed between March 15 and July 21, 2022. Relevant and accessible articles and abstracts published after 2006 and in English only were included. RESULTS Simulation-based cataract surgery is associated with better outcomes in the operating room and faster surgeries. Construct validity has been established across different procedures and levels in simulation-based cataract surgery and simulation-based vitreoretinal surgery. Other simulation-based procedures indicate promising results but in general lack evidence-based validity. DISCUSSION This narrative review highlights and evaluates the current and relevant literature of modern educational simulation-based tools to train ophthalmology residents in different fundamental skills like simulation-based ophthalmoscopy and complex surgical procedures like simulation-based cataract surgery and vitreoretinal surgery. Some studies attempt to develop simulators for the use in education of ophthalmology residents. Other studies strive to establish validity of the respective procedures or modern education tools and some studies investigate the effect of simulation-based training. The most validated modern educational simulation-based tool is the Eyesi Surgical Simulator (VRmagic, Germany). However, other modern educational simulation-based tools have also been evaluated, including the HelpMeSee Eye Surgery Simulator (HelpMeSee Inc., New York, USA) and the MicroVisTouch Surgical Simulator (ImmersiveTouch, USA). CONCLUSION Simulation-based training has already been established for residents in ophthalmology to benefit the most from skill-demanding procedures resulting in better learning and better patient handling. Future studies should aim to validate more simulation-based procedures for the teaching of ophthalmology residents so that the evidence is kept at a high standard.
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Affiliation(s)
- Simon J Lowater
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna S Vergmann
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
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Deuchler S, Scholtz J, Ackermann H, Seitz B, Koch F. Implementation of microsurgery simulation in an ophthalmology clerkship in Germany: a prospective, exploratory study. BMC MEDICAL EDUCATION 2022; 22:599. [PMID: 35922857 PMCID: PMC9351152 DOI: 10.1186/s12909-022-03634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Microsurgery is a growing field which requires significant precision and skill. Eyesi Surgical, which is usually introduced during residency or fellowship, is an ophthalmologic microsurgery simulator which allows users to practice abstract microsurgical skills and more specialized skills. The purpose of this study was to assess the inclusion of microsurgical simulation training during medical school. METHODS Seventy-nine German medical students in their 10th semester of education completed up to two days of training on the simulator during their ophthalmology clerkship. They received an objective numeric score based on simulator performance and completed pre and post training subjective questionnaires. RESULTS There was no relationship found between students' Eyesi Surgical performance scores and their specialty interests (p = .8). The majority of students (73.4%) rated their microsurgical skills to be higher after simulator training than before training (p < 0.001). 92.4% of students found the Eyesi Surgical to be a useful component of the ophthalmology clerkship. Objective scores from Navigation Training Level 1 showed that students achieved better results in the criteria categories of Completing Objects and Tissue Treatment than in the categories of Instrument and Microscope Handling. The mean Total Score was 25.7 (± 17.5) out of a possible 100 points. CONCLUSION The inclusion of surgical simulation in the ophthalmology clerkship led to increased confidence in the microsurgical skills of medical students. Offering surgical simulation training prior to residency can help to expose students to surgical fields, identify those that have particular talent and aptitude for surgery, and assist them in deciding which specialty to pursue.
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Affiliation(s)
- Svenja Deuchler
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany.
- Department of Ophthalmology, Saarland University Medical Center, 66421, Homburg/Saar, Germany.
- Department of Ophthalmology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Julia Scholtz
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66421, Homburg/Saar, Germany
| | - Frank Koch
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
- Department of Ophthalmology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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Khimani K, Koshevarova V, Mathew AA, Gupta AK, Schmitz-Brown M, Gupta PK. Video Game Warm-Up May Suggest Improvement in Ophthalmic Surgical Simulator Performance in Surgically Naïve Students. Clin Ophthalmol 2022; 16:2561-2568. [PMID: 35978609 PMCID: PMC9377345 DOI: 10.2147/opth.s369697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Karima Khimani
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Alfred A Mathew
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Akshaya K Gupta
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Mary Schmitz-Brown
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Praveena K Gupta
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Correspondence: Praveena K Gupta, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555-1108, USA, Tel +409 747 5823, Fax +1 409 747 5824, Email
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Bube SH, Kingo PS, Madsen MG, Vásquez JL, Norus T, Olsen RG, Dahl C, Hansen RB, Konge L, Azawi N. National Implementation of Simulator Training Improves Transurethral Resection of Bladder Tumours in Patients. EUR UROL SUPPL 2022; 39:29-35. [PMID: 35528788 PMCID: PMC9068726 DOI: 10.1016/j.euros.2022.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/02/2022] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analyses Results and limitations Conclusions Patient summary
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Abstract
Ophthalmology is a medical profession with a tradition in teaching that has developed throughout history. Although ophthalmologists are generally considered to only prescribe contact lenses, and they handle more than half of eye-related enhancements, diagnoses, and treatments. The training of qualified ophthalmologists is generally carried out under the traditional settings, where there is a supervisor and a student, and training is based on the use of animal eyes or artificial eye models. These models have significant disadvantages, as they are not immersive and are extremely expensive and difficult to acquire. Therefore, technologies related to Augmented Reality (AR) and Virtual Reality (VR) are rapidly and prominently positioning themselves in the medical sector, and the field of ophthalmology is growing exponentially both in terms of the training of professionals and in the assistance and recovery of patients. At the same time, it is necessary to highlight and analyze the developments that have made use of game technologies for the teaching of ophthalmology and the results that have been obtained. This systematic review aims to investigate software and hardware applications developed exclusively for educational environments related to ophthalmology and provide an analysis of other related tools. In addition, the advantages and disadvantages, limitations, and challenges involved in the use of virtual reality, augmented reality, and game technologies in this field are also presented.
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De Mol L, Vangeneugden J, Desender L, Van Herzeele I, Konge L, Willaert W. Using an application to measure trainees' procedural knowledge before chest tube insertion. Postgrad Med J 2022:7150860. [PMID: 37137554 DOI: 10.1136/postgradmedj-2022-141580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF THE STUDY To collect validity evidence for the chest tube insertion (CTI) test mode on the medical simulation application Touch Surgery. This was done by using Messick's contemporary framework. METHODS Novice, intermediate and experienced participants provided informed consent and demographic information. After familiarisation with the application, they completed the CTI test mode. Validity evidence was collected from four sources: content, response process, relation to other variables and consequences. A post-study questionnaire with 5-point Likert scales assessed the perceived realism, relevance and utility of the assessment. Mean scores of the three groups were compared. RESULTS A total of 25 novices, 11 intermediates and 19 experienced participants were recruited. Content evidence was collected by an expert in CTI and was based on published literature and guidelines. All users were familiarised with the application, and received standardised instructions throughout the test. Most users rated the simulation as realistic and suitable to assess cognitive skills. Novices received significantly lower (55.9±7.5) test mode scores than intermediates (80.6±4.4) (p<0.001) and experienced participants (82.3±5.3) (p<0.001). There was no significant difference in score between intermediate and experienced participants (p=0.75). Consequences evidence was provided by establishing a pass/fail score of 71% using the contrasting groups method, which resulted in one observed false positive and no false negatives. CONCLUSION A robust validity argument was constructed for the CTI test mode, which can be implemented in surgical curricula to assess learners' cognitive skills prior to hands-on simulation practice.
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Affiliation(s)
- Leander De Mol
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Joris Vangeneugden
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Liesbeth Desender
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | | | - Lars Konge
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Copenhagen, Denmark
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Implementation of Sequence-Based Classification Methods for Motion Assessment and Recognition in a Traditional Chinese Sport (Baduanjin). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031744. [PMID: 35162767 PMCID: PMC8834705 DOI: 10.3390/ijerph19031744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
This study aimed to assess the motion accuracy of Baduanjin and recognise the motions of Baduanjin based on sequence-based methods. Motion data of Baduanjin were measured by the inertial sensor measurement system (IMU). Fifty-four participants were recruited to capture motion data. Based on the motion data, various sequence-based methods, namely dynamic time warping (DTW) combined with classifiers, hidden Markov model (HMM), and recurrent neural networks (RNNs), were applied to assess motion accuracy and recognise the motions of Baduanjin. To assess motion accuracy, the scores for motion accuracies from teachers were used as the standard to train the models on the different sequence-based methods. The effectiveness of Baduanjin motion recognition with different sequence-based methods was verified. Among the methods, DTW + k-NN had the highest average accuracy (83.03%) and shortest average processing time (3.810 s) during assessing. In terms of motion reorganisation, three methods (DTW + k-NN, DTW + SVM, and HMM) had the highest accuracies (over 99%), which were not significantly different from each other. However, the processing time of DTW + k-NN was the shortest (3.823 s) compared to the other two methods. The results show that the motions of Baduanjin could be recognised, and the accuracy can be assessed through an appropriate sequence-based method with the motion data captured by IMU.
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Guérinot C, Marcon V, Godard C, Blanc T, Verdier H, Planchon G, Raimondi F, Boddaert N, Alonso M, Sailor K, Lledo PM, Hajj B, El Beheiry M, Masson JB. New Approach to Accelerated Image Annotation by Leveraging Virtual Reality and Cloud Computing. FRONTIERS IN BIOINFORMATICS 2022; 1:777101. [PMID: 36303792 PMCID: PMC9580868 DOI: 10.3389/fbinf.2021.777101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
Three-dimensional imaging is at the core of medical imaging and is becoming a standard in biological research. As a result, there is an increasing need to visualize, analyze and interact with data in a natural three-dimensional context. By combining stereoscopy and motion tracking, commercial virtual reality (VR) headsets provide a solution to this critical visualization challenge by allowing users to view volumetric image stacks in a highly intuitive fashion. While optimizing the visualization and interaction process in VR remains an active topic, one of the most pressing issue is how to utilize VR for annotation and analysis of data. Annotating data is often a required step for training machine learning algorithms. For example, enhancing the ability to annotate complex three-dimensional data in biological research as newly acquired data may come in limited quantities. Similarly, medical data annotation is often time-consuming and requires expert knowledge to identify structures of interest correctly. Moreover, simultaneous data analysis and visualization in VR is computationally demanding. Here, we introduce a new procedure to visualize, interact, annotate and analyze data by combining VR with cloud computing. VR is leveraged to provide natural interactions with volumetric representations of experimental imaging data. In parallel, cloud computing performs costly computations to accelerate the data annotation with minimal input required from the user. We demonstrate multiple proof-of-concept applications of our approach on volumetric fluorescent microscopy images of mouse neurons and tumor or organ annotations in medical images.
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Affiliation(s)
- Corentin Guérinot
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
- Sorbonne Université, Collège Doctoral, Paris, France
| | - Valentin Marcon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Charlotte Godard
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Thomas Blanc
- Sorbonne Université, Collège Doctoral, Paris, France
- Laboratoire Physico-Chimie, Institut Curie, PSL Research University, CNRS UMR168, Paris, France
| | - Hippolyte Verdier
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Histopathology and Bio-Imaging Group, Sanofi R&D, Vitry-Sur-Seine, France
- Université de Paris, UFR de Physique, Paris, France
| | - Guillaume Planchon
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Francesca Raimondi
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
- Unité Médicochirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Unit, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
- UMR-1163 Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mariana Alonso
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Kurt Sailor
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Pierre-Marie Lledo
- Perception and Memory Unit, CNRS UMR3571, Institut Pasteur, Paris, France
| | - Bassam Hajj
- Sorbonne Université, Collège Doctoral, Paris, France
- École Doctorale Physique en Île-de-France, PSL University, Paris, France
| | - Mohamed El Beheiry
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
| | - Jean-Baptiste Masson
- Decision and Bayesian Computation, USR 3756 (C3BI/DBC) & Neuroscience Department CNRS UMR 3751, Université de Paris, Institut Pasteur, Paris, France
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Myers TG, Marsh JL, Nicandri G, Gorczyca J, Pellegrini VD. Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency: Competency-Based Medical Education and Simulation. J Bone Joint Surg Am 2022; 104:79-91. [PMID: 34752441 DOI: 10.2106/jbjs.20.01553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Orthopaedic education should produce surgeons who are competent to function independently and can obtain and maintain board certification. ➤ Contemporary orthopaedic training programs exist within a fixed 5-year time frame, which may not be a perfect match for each trainee. ➤ Most modern orthopaedic residencies have not yet fully adopted objective, proficiency-based, surgical skill training methods despite nearly 2 decades of evidence supporting the use of this methodology. ➤ Competency-based medical education backed by surgical simulation rooted in proficiency-based progression has the potential to address surgical skill acquisition challenges in orthopaedic surgery.
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Affiliation(s)
- Thomas G Myers
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | | | - Gregg Nicandri
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - John Gorczyca
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York
| | - Vincent D Pellegrini
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Naples R, French JC, Han AY, Lipman JM, Awad MM. The Impact of Simulation Training on Operative Performance in General Surgery: Lessons Learned from a Prospective Randomized Trial. J Surg Res 2021; 270:513-521. [PMID: 34801802 DOI: 10.1016/j.jss.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/26/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Practice in the simulated environment can improve surgical skills. However, the transfer of open complex surgical skills to the operating room is unclear. This study evaluated the effect of resident operative performance following a simulation experience on a hand-sewn small bowel anastomosis and determined the impact of utilizing proficiency-based training. METHODS Nine categorical interns performed a hand-sewn small bowel anastomosis in the operating room prior to (pre-test) and following (post-test) a 3-h simulation training session with an assessment at the end. Participants were randomly assigned to 1of 2 simulation training groups: proficiency-based or standard. Operative performance was videotaped. 2 independent, blinded faculty surgeons assessed performances by a global rating scale. Pre- and post-confidence levels were obtained on a 5-point Likert scale. RESULTS Overall, pre-test and post-test operative performance was similar (3 [IQR, 2.5 -3.5] versus 3 [IQR, 3 -3], P = 0.59). Furthermore, no difference was observed in the post-test performance with proficiency-based or standard training (3 [IQR, 3 -3] versus 3 [IQR, 3 -3], P = 0.73). Self-reported confidence with the skills, however, significantly improved (median 1 versus 4, P = 0.007). CONCLUSIONS In this prospective, randomized study, we did not observe an improvement in operative performance following simulation instruction and assessment, with both training groups. Overcoming barriers to skills transfer will be paramount in the future to optimize simulation training in general surgery. These findings highlight the importance of continued study for the ideal conditions and timing of technical skills training.
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Affiliation(s)
- Robert Naples
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
| | - Judith C French
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Amy Y Han
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Michael M Awad
- Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Santa Maria C, Sung CK, Lee JY, Chhetri DK, Mendelsohn AH, Dewan K. Flexible Bronchoscopy Simulation as a Tool to Improve Surgical Skills in Otolaryngology Residency. OTO Open 2021; 5:2473974X211056530. [PMID: 34734157 PMCID: PMC8558810 DOI: 10.1177/2473974x211056530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the benefits of simulation to teach flexible bronchoscopy. Study Design A prospective cohort study to assess the bronchoscopic skills of residents in an otolaryngology training program using a commercially available bronchoscopy simulator. Setting Tertiary care otolaryngology residency program. Methods Thirty-two otolaryngology residents and 4 expert faculty across 2 academic institutions were assessed on 3 flexible bronchoscopy tasks: diagnostic bronchoscopy, foreign body removal, and tracheal lesion biopsy. Performance was evaluated with a modified version of the validated Bronchoscopy Skills and Tasks Assessment Tool. At 1 of the 2 academic institutions, an additional tool was implemented to evaluate the simulator. Results There was a correlation between postgraduate training year and time taken to complete tasks, including bronchoscopy, foreign body extraction, and passing through the glottis (P < .001, P = .04, and P < .01, respectively). There was a significant difference between residents and faculty laryngologists for a range of skills and tasks, including percentage of time in middle lumen, contact with bronchial walls, inadvertent esophagus entry, and biopsy of healthy tissue (P < .001, P = .003, P < .001, and P < .001). Additionally, increasing postgraduate level was correlated with a higher percentage of time in the center of the lumen and reduced time to task completion (P = .05 and P < .001). Of 32 residents, 20 evaluated the simulator on its realism, with an average score of 4.1 of 5. Conclusion The commercially available flexible bronchoscopy simulator provides a valid assessment of bronchoscopic skill and is a useful tool for practicing bronchoscopy in a safe, controlled environment. Level of Evidence Individual cohort study.
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Affiliation(s)
- Chloe Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Chi-Kwang Sung
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Jennifer Y Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Dinesh K Chhetri
- Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Abie H Mendelsohn
- Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Karuna Dewan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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Andersen SAW, Nayahangan LJ, Park YS, Konge L. Use of Generalizability Theory for Exploring Reliability of and Sources of Variance in Assessment of Technical Skills: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1609-1619. [PMID: 33951677 DOI: 10.1097/acm.0000000000004150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Competency-based education relies on the validity and reliability of assessment scores. Generalizability (G) theory is well suited to explore the reliability of assessment tools in medical education but has only been applied to a limited extent. This study aimed to systematically review the literature using G-theory to explore the reliability of structured assessment of medical and surgical technical skills and to assess the relative contributions of different factors to variance. METHOD In June 2020, 11 databases, including PubMed, were searched from inception through May 31, 2020. Eligible studies included the use of G-theory to explore reliability in the context of assessment of medical and surgical technical skills. Descriptive information on study, assessment context, assessment protocol, participants being assessed, and G-analyses was extracted. Data were used to map G-theory and explore variance components analyses. A meta-analysis was conducted to synthesize the extracted data on the sources of variance and reliability. RESULTS Forty-four studies were included; of these, 39 had sufficient data for meta-analysis. The total pool included 35,284 unique assessments of 31,496 unique performances of 4,154 participants. Person variance had a pooled effect of 44.2% (95% confidence interval [CI], 36.8%-51.5%). Only assessment tool type (Objective Structured Assessment of Technical Skills-type vs task-based checklist-type) had a significant effect on person variance. The pooled reliability (G-coefficient) was 0.65 (95% CI, .59-.70). Most studies included decision studies (39, 88.6%) and generally seemed to have higher ratios of performances to assessors to achieve a sufficiently reliable assessment. CONCLUSIONS G-theory is increasingly being used to examine reliability of technical skills assessment in medical education, but more rigor in reporting is warranted. Contextual factors can potentially affect variance components and thereby reliability estimates and should be considered, especially in high-stakes assessment. Reliability analysis should be a best practice when developing assessment of technical skills.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- S.A.W. Andersen is postdoctoral researcher, Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, Capital Region of Denmark, and Department of Otolaryngology, The Ohio State University, Columbus, Ohio, and resident in otorhinolaryngology, Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark; ORCID: https://orcid.org/0000-0002-3491-9790
| | - Leizl Joy Nayahangan
- L.J. Nayahangan is researcher, CAMES, Center for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark; ORCID: https://orcid.org/0000-0002-6179-1622
| | - Yoon Soo Park
- Y.S. Park is director of health professions education research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-8583-4335
| | - Lars Konge
- L. Konge is professor of medical education, University of Copenhagen, and head of research, CAMES, Center for Human Resources and Education, Capital Region of Denmark, Copenhagen, Denmark; ORCID: https://orcid.org/0000-0002-1258-5822
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Petersen SB, Vestergaard AH, Thomsen ASS, Konge L, Cour ML, Grauslund J, Vergmann AS. Pretraining of basic skills on a virtual reality vitreoretinal simulator: A waste of time. Acta Ophthalmol 2021; 100:e1074-e1079. [PMID: 34609052 DOI: 10.1111/aos.15039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate whether pretraining of basic skills in virtual vitreoretinal surgery affected the performance curve when proceeding to procedure-specific modules. METHODS This study was a prospective, randomized, controlled, two-centre study. Medical students were randomized into two groups: Group 1 pretrained basic psycho-motor skills (Navigation Training level 2 and Bimanual Training level 3) until they reached their performance curve plateau. Hereafter, both groups trained on the procedure-specific modules (Posterior Hyaloid level 3 and ILM Peeling level 3) until they reached their performance curve plateau. Plateau was defined as three consecutive sessions with the same score with an acceptable variation. The primary outcome was time used to reach performance curve plateau in the procedure-specific modules. RESULTS A total of 68 medical students were included, and equally randomized into two groups. The participants in Group 1 used a median time of 88 minutes to reach plateau in the basic skills modules but did not differ from Group 2 in time to reach plateau on the procedure-specific modules (183 min versus 210 min, p = 0.40) or in the amplitude of plateau. Group 1 and 2 differed significantly in the starting score of ILM peeling level 3 (0 (0-0) versus 3.5 (0-75), p = 0.03). CONCLUSION We were not able to show positive skill transfer from basic skills training to the procedure-specific modules in time, starting score or amplitude of plateau. Thus, we recommend that aspiring vitreoretinal surgeons proceed directly to simulation-based training of procedures instead of spending valuable training time on basic skills training.
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Affiliation(s)
- Sarah Bjørn Petersen
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Health Science University of Southern Denmark Odense Denmark
| | - Anders Højslet Vestergaard
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Health Science University of Southern Denmark Odense Denmark
| | - Ann Sofia Skou Thomsen
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR and Education Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Centre for HR and Education Copenhagen Denmark
| | - Morten La Cour
- Department of Ophthalmology Rigshospitalet‐Glostrup Glostrup Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Health Science University of Southern Denmark Odense Denmark
| | - Anna Stage Vergmann
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Regional Center for Technical Simulation Region of Southern Denmark Odense Denmark
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Abstract
OBJECTIVE This systematic review aims to examine the use of standard-setting methods in the context of simulation-based training of surgical procedures. SUMMARY OF BACKGROUND Simulation-based training is increasingly used in surgical education. However, it is important to determine which level of competency trainees must reach during simulation-based training before operating on patients. Therefore, pass/fail standards must be established using systematic, transparent, and valid methods. METHODS Systematic literature search was done in four databases (Ovid MEDLINE, Embase, Web of Science, and Cochrane Library). Original studies investigating simulation-based assessment of surgical procedures with application of a standard setting were included. Quality of evidence was appraised using GRADE. RESULTS Of 24,299 studies identified by searches, 232 studies met the inclusion criteria. Publications using already established standard settings were excluded (N = 70), resulting in 162 original studies included in the final analyses. Most studies described how the standard setting was determined (N = 147, 91%) and most used the mean or median performance score of experienced surgeons (n = 65, 40%) for standard setting. We found considerable differences across most of the studies regarding study design, set-up, and expert level classification. The studies were appraised as having low and moderate evidence. CONCLUSION Surgical education is shifting towards competency-based education, and simulation-based training is increasingly used for acquiring skills and assessment. Most studies consider and describe how standard settings are established using more or less structured methods but for current and future educational programs, a critical approach is needed so that the learners receive a fair, valid and reliable assessment.
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Abstract
PURPOSE OF REVIEW Artificial intelligence and deep learning have become important tools in extracting data from ophthalmic surgery to evaluate, teach, and aid the surgeon in all phases of surgical management. The purpose of this review is to highlight the ever-increasing intersection of computer vision, machine learning, and ophthalmic microsurgery. RECENT FINDINGS Deep learning algorithms are being applied to help evaluate and teach surgical trainees. Artificial intelligence tools are improving real-time surgical instrument tracking, phase segmentation, as well as enhancing the safety of robotic-assisted vitreoretinal surgery. SUMMARY Similar to strides appreciated in ophthalmic medical disease, artificial intelligence will continue to become an important part of surgical management of ocular conditions. Machine learning applications will help push the boundaries of what surgeons can accomplish to improve patient outcomes.
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Affiliation(s)
- Kapil Mishra
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California, USA
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Ong CW, Tan MCJ, Lam M, Koh VTC. Applications of Extended Reality in Ophthalmology: Systematic Review. J Med Internet Res 2021; 23:e24152. [PMID: 34420929 PMCID: PMC8414293 DOI: 10.2196/24152] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/19/2020] [Accepted: 04/06/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Virtual reality, augmented reality, and mixed reality make use of a variety of different software and hardware, but they share three main characteristics: immersion, presence, and interaction. The umbrella term for technologies with these characteristics is extended reality. The ability of extended reality to create environments that are otherwise impossible in the real world has practical implications in the medical discipline. In ophthalmology, virtual reality simulators have become increasingly popular as tools for surgical education. Recent developments have also explored diagnostic and therapeutic uses in ophthalmology. OBJECTIVE This systematic review aims to identify and investigate the utility of extended reality in ophthalmic education, diagnostics, and therapeutics. METHODS A literature search was conducted using PubMed, Embase, and Cochrane Register of Controlled Trials. Publications from January 1, 1956 to April 15, 2020 were included. Inclusion criteria were studies evaluating the use of extended reality in ophthalmic education, diagnostics, and therapeutics. Eligible studies were evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Relevant studies were also evaluated using a validity framework. Findings and relevant data from the studies were extracted, evaluated, and compared to determine the utility of extended reality in ophthalmology. RESULTS We identified 12,490 unique records in our literature search; 87 met final eligibility criteria, comprising studies that evaluated the use of extended reality in education (n=54), diagnostics (n=5), and therapeutics (n=28). Of these, 79 studies (91%) achieved evidence levels in the range 2b to 4, indicating poor quality. Only 2 (9%) out of 22 relevant studies addressed all 5 sources of validity evidence. In education, we found that ophthalmic surgical simulators demonstrated efficacy and validity in improving surgical performance and reducing complication rates. Ophthalmoscopy simulators demonstrated efficacy and validity evidence in improving ophthalmoscopy skills in the clinical setting. In diagnostics, studies demonstrated proof-of-concept in presenting ocular imaging data on extended reality platforms and validity in assessing the function of patients with ophthalmic diseases. In therapeutics, heads-up surgical systems had similar complication rates, procedural success rates, and outcomes in comparison with conventional ophthalmic surgery. CONCLUSIONS Extended reality has promising areas of application in ophthalmology, but additional high-quality comparative studies are needed to assess their roles among incumbent methods of ophthalmic education, diagnostics, and therapeutics.
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Affiliation(s)
- Chee Wui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcus Chun Jin Tan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Michael Lam
- Department of Ophthalmology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Oh S, Kim DK. Machine-Deep-Ensemble Learning Model for Classifying Cybersickness Caused by Virtual Reality Immersion. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 24:729-736. [PMID: 34375142 DOI: 10.1089/cyber.2020.0613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study aims to classify cybersickness (CS) caused by virtual reality (VR) immersion through a machine-deep-ensemble learning model. The heart rate variability and respiratory signal parameters of 20 subjects were measured, while watching a VR video for ∼5 minutes. After the experiment, the subjects were examined for CS and questioned to determine their CS states. Based on the results, we constructed a machine-deep-ensemble learning model that could identify and classify VR immersion CS among subjects. The ensemble model comprised four stacked machine learning models (support vector machine [SVM], k-nearest neighbor [KNN], random forest, and AdaBoost), which were used to derive prediction data, and then, classified the prediction data using a convolution neural network. This model was a multiclass classification model, allowing us to classify subjects' CS into three states (neutral, non-CS, and CS). The accuracy of SVM, KNN, random forest, and AdaBoost was 94.23 percent, 92.44 percent, 93.20 percent, and 90.33 percent, respectively, and the ensemble model could classify the three states with an accuracy of 96.48 percent. This implied that the ensemble model has a higher classification performance than when each model is used individually. Our results confirm that CS caused by VR immersion can be detected as physiological signal data with high accuracy. Moreover, our proposed model can determine the presence or absence of CS as well as the neutral state. Clinical Trial Registration Number: 20-2021-1.
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Affiliation(s)
- SeungJun Oh
- Department of Sports ICT Convergence, Sangmyung University Graduate School, Seoul, Republic of Korea
| | - Dong-Keun Kim
- Department of Human-Centered Artificial Intelligence, Institute of Intelligence Informatics Technology, Sangmyung University, Seoul, Republic of Korea
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Engberg M, Hörer T, Rasmussen TE, Taudorf M, Nayahangan LJ, Rasmussen NK, Russell L, Konge L, Lönn L. Developing a tool to assess competence in resuscitative endovascular balloon occlusion of the aorta: An international Delphi consensus study. J Trauma Acute Care Surg 2021; 91:310-317. [PMID: 34259442 DOI: 10.1097/ta.0000000000003191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergency procedure that is potentially lifesaving in major noncompressible torso hemorrhage. It may also improve outcome in nontraumatic cardiac arrest. However, the procedure can be technically challenging and requires the immediate presence of a qualified operator. Thus, evidence-based training and assessment of operator skills are essential for successful implementation and patient safety. A prerequisite for this is a valid and reliable assessment tool specific for the procedure. The aim of this study was to develop a tool for assessing procedural competence in REBOA based on best-available knowledge from international experts in the field. METHODS We invited international REBOA experts from multiple specialties to participate in an anonymous three-round iterative Delphi study to reach consensus on the design and content of an assessment tool. In round 1, participants suggested items to be included. In rounds 2 and 3, the relevance of each suggested item was evaluated by all participants to reach consensus. Interround data processing was done systematically by a steering group. RESULTS Forty panelists representing both clinical and educational expertise in REBOA from 16 countries (in Europe, Asia, and North and South America) and seven different specialties participated in the study. After 3 Delphi rounds and 532 initial item suggestions, the panelists reached consensus on a 10-item assessment tool with behaviorally anchored rating scales. It includes assessment of teamwork, procedure time, selection and preparation of equipment, puncture technique, guidewire handling, sheath handling, placement of REBOA catheter, occlusion, and evaluation. CONCLUSION We present the REBOA-RATE assessment tool developed systematically by international experts in the field to optimize content validity. Following further studies of its validity and reliability, this tool represents an important next step in evidence-based training programs in REBOA, for example, using mastery learning. LEVEL OF EVIDENCE Therapeutic, level V.
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Affiliation(s)
- Morten Engberg
- From the Centre for Human Resources and Education, Capital Region of Denmark (M.E., L.J.N., L.R., L.K.), Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark; Department of Clinical Medicine (M.E., N.K.R., L.K., L.L.), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiothoracic and Vascular Surgery (T.H.), and Department of Surgery (T.H.), Faculty of Life Science, Örebro University Hospital, Örebro, Sweden; Walter Reed National Military Medical Center (T.E.R.); National Institutes of Health Clinical Center (T.E.R.), Bethesda, Maryland; Department of Radiology (M.T., N.K.R., L.L.), and Department of Intensive Care (L.R.), Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Effect of virtual reality simulation training on real-life cataract surgery complications: systematic literature review. J Cataract Refract Surg 2021; 47:400-406. [PMID: 32675654 DOI: 10.1097/j.jcrs.0000000000000323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/21/2020] [Indexed: 01/30/2023]
Abstract
Virtual reality simulation (VRS) has become progressively popular as a training tool in ophthalmology. However, debate continues as to whether VRS has resulted in better outcomes for patients after cataract surgery. Accordingly, a qualitative systematic literature review was conducted to identify whether VRS training results in a reduced complication rate after real-life cataract surgery. Included studies measured the effect of VRS on real-life patient outcomes after cataract surgery. Databases searched included MEDLINE (Ovid), The Cochrane Library, Web of Science, PubMed, and CINAHL. A total of 1917 studies were identified, of which 10 studies were included, spanning from 2011 to 2020. The studies comprised 471 ophthalmological residents, with their complication rates assessed after 30 462 cataract surgery procedures. This systematic literature review indicates that VRS seems to be most helpful in reducing the rate of posterior capsular rupture or errant curvilinear capsulorrhexis and had limited evidence in reducing the rate of other complications.
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Beqari J, Seymour NE. Application of technology to educational needs in surgery. J Surg Oncol 2021; 124:181-192. [PMID: 34245576 DOI: 10.1002/jso.26512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 01/22/2023]
Abstract
Innovations in surgical education follow advancing clinical technology. New surgical methods have prompted demand for systematic methods to leverage computing power and internet tools to achieve proficiency-based training goals. Virtual reality, high-fidelity patient simulation, web-based resources to facilitate performance assessment, and telementoring have become mainstream practices, although patient outcomes benefits are not well studied. Remote virtual meeting and mentoring have had transformative effects on resident experiences, the full effects of which remain to be seen.
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Affiliation(s)
- Jorind Beqari
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Neal E Seymour
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
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The effect of surgical abstinence on the risk of posterior capsule rupture during cataract surgery. J Cataract Refract Surg 2021; 48:173-176. [PMID: 34261984 DOI: 10.1097/j.jcrs.0000000000000741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the impact of surgery restrictions on cataract surgery performance. SETTING Moorfields Eye Hospital, NHS Foundation Trust, London, UK. DESIGN Retrospective, observational cross-sectional study. METHODS Single-centre, retrospective review of all patients that underwent phacoemulsification surgery at Moorfields Eye Hospital, between September 2019 and January 2021. Our main outcome measure was Posterior Capsule Rupture (PCR) rate before and after COVID-19 imposed restrictions to elective cataract surgery. RESULTS We identified a total of 15689 surgeries in the period of the study performed by 256 different surgeons. In the pre-surgery restriction period (September 2019 to March 2020), the PCR rate was 0.99% while on surgery restarting after 19 weeks, the PCR rate spiked to 1.62% (Odds Ratio 1.65; p=0.001; CI 1.24-2.20; Relative Risk: 1.64). CONCLUSIONS COVID-19 pandemic provided a unique opportunity to assess a large group of surgeons' performances after prolonged surgical abstinence. A 19-weeks period of restrictions in surgical activity showed an increased incidence of PCR complications. This is relevant as it can concern any surgeon on extended time off work such as sickness, sabbatical, research and parental leave. Supporting strategies should be implemented by associated regulators to minimize this negative impact.
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